tbuckley/cabot-search huggingface dataset:
Abstract 12962: Circulating Biomarkers Are Associated With Left and Right Ventricular Strain Measured by Cardiac Magnetic Resonance Imaging in Repaired Tetralogy of Fallot Patients
Authors: Chandni H Patel, Michael DiLorenzo, Andrea Jones, Elizabeth Goldmuntz, Mark A Fogel, Laura M Mercer-Rosa
Journal: Circulation (2022)

Introduction: Circulating biomarkers thought to represent myocardial fibrosis and stretch are understudied in repaired tetralogy of Fallot (TOF) patients. We aim to identify associations between biomarkers and right ventricular (RV) and left ventricular (LV) function measured as strain by cardiac magnetic resonance (CMR) in repaired TOF patients. Methods: N-terminal-pro hormone BNP (NTproBNP), galectin-3 (Gal-3) and matrix metalloproteinase 1 (MMP1) were measured in serum obtained from TOF patients at the time of standard of care CMR. High and low biomarker groups were created using the median value. CMR strain analysis was performed using cvi42 (Circle Cardiovascular Imaging). CMR parameters were compared by biomarker group using two sample Student’s t tests (given normal distribution), and Pearson correlation coefficients were obtained. Results: Twenty patients were analyzed (45% male). Median age at TOF repair and CMR was 4.1 months (interquartile range [IQR] 1.6, 6.8) and 11.5 years (IQR 10, 15.5), respectively. Patients with higher Gal-3 had worse LV global longitudinal strain (Table) . Those with higher NTproBNP had worse RV global longitudinal and circumferential strain, and those with greater MMP1 values had worse LV global circumferential strain. Gal-3 was moderately inversely correlated with pulmonary regurgitant fraction and RV end-systolic volume (Table) . NTproBNP values were moderately directly correlated with RV mass. MMP1 values were moderately directly correlated with RV end-systolic volume and inversely correlated with RV ejection fraction. Conclusions: The three biomarkers investigated have associations with right and left ventricular strain. Gal-3 and MMP1 are potential biomarkers of LV function, while NTproBNP is a potential biomarker of RV function. Further, Gal-3 may inform more favorable RV remodeling. Future studies will determine if circulating biomarkers will identify early ventricular dysfunction after TOF repair.
Abstract 14095: Factors Influencing Timely Recognition and Treatment of Severe Hypertension in Pregnancy
Authors: Jay Parekh, Jane Morrison, Tassos Kyriakides, Laura A Magee, Jean Tornatore, Tabassum Firoz
Journal: Circulation (2022)

Background: Severe hypertension is an obstetric emergency. Timely identification and management can reduce risk of serious events. Aims of our study were to 1)assess whether severe hypertension is being recognized and managed within the recommended time frame and 2)evaluate the factors that are associated with timely identification and treatment of severe maternal hypertension. Methods: A retrospective study of pregnant and postpartum women presenting with severe hypertension to tertiary care hospital between 1/1/19 to 12/1/19. Main outcome measures were ‘time to repeat blood pressure check(TTC)’ and ‘time interval between confirmation of severe hypertension and initiation of pharmacotherapy(TTT)’. We examined the association of the type of hospital unit, time of day of presentation and race/ethnicity with the outcome measures. Results: A total of 656 women were included in the study. Median time for repeat blood pressure check was 16 minutes. Only 46.2% of women had a repeat blood pressure check within 15 minutes. Median interval between confirmation of severe hypertension and initiation of therapy was 38.5 minutes. 63.3% of women were treated within the recommended time frame of 60 minutes. Both timely blood pressure re-check(15.6% vs 51.4%, p &lt; 0.001) and initiation of treatment(38.5% vs 70.8%, p &lt; 0.001) were significantly lower in the emergency department (ED). TTC(57.9% vs 31.4%, p &lt; 0.001) and TTT(86.4% vs 42%, p &lt; 0.001) were significantly better in the labor and delivery unit. Time of day(day 51.6% vs night 57.3%, p = 0.15) and race/ethnicity(black 57.1% vs non-black 51.6%, p = 0.16) were not associated with delay in repeat blood pressure check. However, black race(46.2% vs 28.6%, p = 0.018) was associated with delayed initiation of therapy compared to non-black patients. Conclusions: We found both the rates of timely identification and treatment of severe maternal hypertension in the ED were lower compared to other units. This points to need for continuous education of ED healthcare providers about timely recognition and management of severe maternal hypertension. We also found racial disparities in timely initiation of therapy, thus demonstrating the need for standardization of protocols.
Abstract 13267: Angina Burden and Coronary Vascular Function in Women With Ischemia and No Obstructive Coronary Arteries—Role of Oxygenation-Sensitive Cardiovascular Magnetic Resonance Imaging
Authors: Julia Visch, Judy M Luu, Elizabeth Hillier, Malik Elharram, James White, Todd Anderson, Matthias Friedrich, Louise Pilote
Journal: Circulation (2022)

Introduction: Patients with ischemia and no obstructive coronary arteries (INOCA) often have coronary microvascular dysfunction (CMD). An association between higher angina burden (lower Seattle Angina Questionnaire [SAQ] scores) and increased severity of CMD has previously been reported. Oxygenation-Sensitive Cardiovascular Magnetic Resonance (OS-CMR) is a novel approach that can potentially evaluate CMD. To date, the relationship between angina burden and OS-CMR biomarkers has not been elucidated. Methods: We investigated the association between angina burden, quantified by the mean and 5 individual components of the SAQ, with measures of myocardial oxygenation, using OS-CMR. More severe CMD is reflected by a decreased % signal intensity (SI) change after hyperventilation (Breathing-enhanced Myocardial REserve, B-MORE), calculated by [(Hyperventilation - Breath Hold)/Breath Hold] x 100%. Univariable linear regression analysis was used to investigate the associations. Results: In 44 women with INOCA (mean age 55.1±0.9 years), B-MORE was 5.0±1.4% (Table). Several components of the SAQ were associated with OS-CMR measures of CMD [physical limitation (R 2 =0.281, Beta=0.530, p=0.042), angina frequency (R 2 =0.216, Beta=0.465, p=0.039), disease perception (R 2 =0.254, Beta=0.504, p=0.024), and the mean overall SAQ (R 2 =0.285, Beta=0.534, p=0.015)] (Panel Figure). Conclusion: In women with INOCA, angina burden is associated with coronary vascular function, as assessed by OS-CMR. Therefore, this novel approach may provide objective information to detect the presence of CMD.
Abstract 14815: Clinical Prediction Model of Growth Rate in Type B Aortic Dissection Using 4D Flow MRI
Authors: Anthony Maroun, Kelly Jarvis, Justin Baraboo, Maurice Pradella, Elizabeth Weiss, Stanley Chu, Ozden Kilinc, Haben Berhane, chris mehta, S Malaisrie, Andrew Hoel, Michael Markl, Bradley D Allen
Journal: Circulation (2022)

Introduction: Chronic type B aortic dissection is often associated with aneurysmal degeneration and rupture of the descending aorta (DAo). Early identification of patients at risk for aneurysmal degeneration could identify candidates for prophylactic surgical intervention. Clinical and static imaging measures (age, early aortic dilation, etc.) have been unable to reliably predict DAo growth rate (GR). Importantly, these measures do not account for dissection hemodynamics, an important driver of GR. We therefore aimed to build a multivariate linear regression model that combines baseline clinical, morphologic, and hemodynamic metrics to predict GR. Methods: Patients who underwent 4D-flow MRI and had ≥9 months of imaging follow-up were identified. Baseline clinical features were obtained from medical records. Morphologic metrics were assessed on baseline imaging and GR (mm/y) was calculated by comparison to follow-up scans. Baseline 4D-flow MRI was used to measure the following parameters in the true lumen: pulse wave velocity (PWV), peak velocity (PV), and forward flow. False lumen thrombus (FLT) was assessed in percentage quartiles (0, 1-25%, 26-50%, 51-75%, &gt;75%) and scored from 0 to 4. Stepwise multivariate regression was conducted to identify a model for best prediction of GR (Figure 1). Results: Thirty-four patients were included (70.0 ± 16.5y; 21 M). On multivariate analysis, we detected a model that significantly correlates with GR (r 2 = 0.55 p &lt; 0.001) by using PWV, FLT, and PV as predictors. In fact, PWV was the strongest predictor overall (r = - 0.54 p = 0.001). Clinical features and other imaging measures showed no association with GR and hence were excluded by stepwise regression analysis. Conclusions: The regression model identified two hemodynamic parameters and FLT as the strongest predictors of GR. This finding suggests that a multitude of hemodynamic factors impact GR and that 4D flow parameters have the potential to improve clinical risk models.
Abstract 14263: Asessment of Pulmonary Vascular Reserve Using Pharmacologic Stress Testing in Patients With Fontan Physiology
Authors: Iman Naimi, Laurent Desjardins, Konstantin Averin
Journal: Circulation (2022)

Introduction: The presence of pulmonary vascular disease (PVD) may be under-recognized during standard hemodynamic evaluation in patients with Fontan physiology. Assessment of pulmonary vascular reserve (VR) (Δ pulmonary artery pressure/Δ cardiac index) utilizing pharmacologic stress testing could be a better way of identifying PVD in pediatric patients. The objective of this study is to diagnose Fontan patients with PVD utilizing pharmacologic stress testing. Hypothesis: Pharmacologic stress testing will unmask Fontan patients as having PVD. Methods: Single center record review of cardiac catheterizations with dobutamine administration in Fontan patients from January 2021 to June 2022. Following acquisition of baseline data on room air, a dobutamine infusion was started at 5 mcg/kg/min with dose escalation as needed until an appropriate heart rate response was achieved. Hemodynamics were reassessed at each dose interval, but data are reported at the highest cardiac index (CI). Abnormal VR was defined as &gt; 3 mmHg/l. Results: Eighteen Fontan patients (87% male) were included. Median age at the time of catheterization was 14 (IQR 11, 16) years with mean duration of Fontan circulation of 9.9 ± 3.9 years. The primary indication for catheterization was exercise intolerance (65%). Dobutamine administration did not result in a significant change in indexed pulmonary vascular resistance (PVRi) (2.1 ± 0.8 v 2.4 ± 1.31 iWU, p = 0.21) or Fontan pressure (12 [IQR 11, 14] v 14 (IQR 12, 15), p=1.0]. Eight patients had a PVRi ≥ 2.0 iWu at baseline; while 4 (22% of the cohort) had a PVRi &lt; 2.0 iWU at baseline but had an abnormal VR. Conclusions: PVD is common in Fontan patients but may be missed in some patients without pharmacologic stress testing. Accurate diagnosis of PVD will allow for optimization of Fontan circulation with pulmonary vasodilators.
Abstract 13181: Accurate, Non-Invasive Monitoring of VO2 Max Using Wearable ECG Technology
Authors: Mark Lilburn, Adrian Deery, Stacey McKenna, Matthew Fitzpatrick, Holly Easlea, Rebecca Funston, Adrian Condon
Journal: Circulation (2022)

Introduction: Maximal aerobic capacity (VO2 max) corresponds to the maximum volume of oxygen the body can utilize during high-intensity exercise and is widely regarded as the criterion measurement for cardiorespiratory fitness (CRF). In addition to its use as a metric to evaluate aerobic endurance, VO2 max has been identified as a significant and independent risk factor for all-cause and disease-specific mortality. The integration of VO2 max functionality into wearable devices allows CRF to be unobtrusively monitored, providing an important insight into clinical health. Methods: ECG data acquired on the non-invasive HeartKey ® Chest Module throughout a multi-stage, high-intensity exercise protocol was used by the HeartKey VO2 Max algorithm to generate a VO2 max rate. The algorithm’s performance was evaluated against data simultaneously collected on gold standard CRF equipment using indirect calorimetry (Korr ® CardioCoach). Participants (N=45) of varying ages and physical fitness were recruited to ensure a wide range of CRF levels were represented. Results: A strong correlational relationship ( R= 0.9) was observed between the HeartKey VO2 max values and those generated on the criterion device. HeartKey VO2 Max algorithm demonstrated high accuracy, with a mean absolute percentage error of ~6% over the 45 subjects. The mean absolute error for the HeartKey algorithm was 3.1 ml/min/kg, with a root mean square error value of 3.9 ml/min/kg. Conclusions: HeartKey generated highly accurate and reliable VO2 max metrics from ECG data collected on a non-obstructive, non-invasive, dry electrode wearable device, with a performance comparable to that of a gold standard indirect calorimetry device. This study highlights the opportunity to make CRF monitoring accessible in everyday scenarios by using wearable ECG devices functionalized with accurate VO2 max capability, which is convenient, cost-effective, and highly scalable.
Abstract 13775: Novel Risk Model of Quantitatively Predicting Recurrence of Atrial Fibrillation After the Cox-Maze IV Procedure
Authors: Long Song, Zenan Jiang, Haoyu Tan, Hao Zhang, Liming Liu
Journal: Circulation (2022)

Introduction: This study developed a novel risk score model for quantitative prediction of the rate of atrial fibrillation (AF) recurrence after the bipolar radiofrequency Cox-maze IV procedure (CMP-IV) in patients with AF and chronic valvular disease. Methods: We enrolled 408 consecutive patients who underwent the CMP-IV concomitant with valve surgeries in our hospital between 2014 and 2021. We randomly divided the cohort into two groups. A ‘development cohort’for model generation (204 patients; 50%) and a ‘test cohort’for model validation (204 patients; 50%) were calculated by Kaplan-Meier survival curve analysis and receiver operating characteristic curve analysis. Results: The median follow-up was 3.5 (interquartile range: 0.9-6.8) years. The 1-, 3-, 5- and 6-year rates of freedom from AF recurrence in the entire cohort were 91.3%, 87.1%, 80.9% and 76.3%, respectively. Risk factors for AF recurrence examined by multivariate Cox regression analysis included preoperative AF duration &gt;4.4 years, postoperative neutrophil/lymphocyte ratio &gt;9.23, anteroposterior diameter of left atrium &gt;51mm before discharge and AF rhythm at discharge(panel A). Points were assigned to each risk factor according to its hazard ratio. A novel risk score model was developed with a range up to 13 points(panel B). High score (≥7) predicted significantly higher rates of AF recurrence after the CMP-IV than low score (0-3) and medium score(4-6) did in both development cohort(panel C) and test cohort(panel D). The area under the receiver operating characteristic curve of the novel risk model score at 1-, 3- and 5-year was 0.72, 0.80 and 0.89 (95% confidence interval: 0.49-0.95, 0.70-0.90 and 0.81-0.96) respectively in the test cohort(panel E). Conclusions: Surgeons should be cautious to apply the CMP-IV in patients with high model score due to higher risk of AF recurrence.
Abstract 13613: Prevalence of Atrial Fibrillation and Procedure-Outcome in Patients Undergoing Catheter Ablation for Premature Ventricular Contractions
Authors: Sanghamitra Mohanty, Sai Shishir Shetty, Karim Baho, Domenico G Della Rocca, ANGEL QUINTERO MAYEDO, Bryan MacDonald, Carola Gianni, Trevor Morris, Rami Helmy, Issa Asfour, Danielle Kessler, Mohamed Bassiouny, G Gallinghouse, John Burkhardt, Rodney Horton, Amin Al-Ahmad, Andrea Natale
Journal: Circulation (2022)

Introduction: Atrial fibrillation (AF) and premature ventricular contractions (PVC) are common arrhythmias encountered in clinical practice. Theoretically, retrograde atrial conduction can occur in the presence of PVC, causing atrial ectopy. However, the clinical significance of this association is not defined yet. Hypothesis: We investigated the prevalence of AF in patients with PVC and its impact on PVC ablation. Methods:: Consecutive patients undergoing PVC ablation at our institution between 2016 and 2019 were included in this analysis. Patients with structural heart disease, hyperthyroidism, malignancy, alcoholism and advanced renal or hepatic disease were excluded. For all patients, 12-lead ECG was used to diagnose AF and assess PVC morphology. During the index procedure, all PVC morphologies were targeted for ablation. Patients were followed up with remote monitoring as well as ICD interrogations and office visits every 6 months for 2 years. Detection of any PVC in the electrogram was considered as recurrence. Results: A total of 394 patients undergoing PVC ablation were included of which 96 (24%) had the documented evidence of AF. Baseline characteristics of the study population without (group 1, n=298) versus with AF (group 2, n=96) is provided in table 1. Clinical parameters were comparable between the groups except age, which was higher in group 2. PVCs with multiple (≥2) morphology were detected at the index procedure in 41 (13.7%) and 58 (60.4%) patients in group 1 and 2 respectively (p &lt;0.001). At 2 years of follow-up, recurrence rate following PVC-ablation was significantly higher in group 2 compared to group 1 (17 (18%) vs 27 (9%), p=0.026). Conclusions: In this consecutive series, AF was documented in 1/4 th of the population undergoing PVC ablation and presence of AF was associated with lower procedural success at long term, which could be attributed to older age and significantly higher prevalence of multiple morphology’ PVCs in the group 2 population.
Abstract 13843: Real World Outcomes of Concomitant Hybrid Convergent Ablation and Left Atrial Appendage Exclusion in Patients With Long Standing Persistent Atrial Fibrillation
Authors: Adnan Ahmed, Rishi Charate, Peter Park, ahmed romeya, Justin Van Meeteren, Rakesh Gopinathannair, Dhanunjaya Lakkireddy, Naga Venkata K Pothineni
Journal: Circulation (2022)

Introduction: Management of patients with long standing persistent atrial fibrillation (LSPAF) presents a clinical challenge. Hybrid convergent ablation has been shown to have superior efficacy compared to endocardial ablation in patients with LSPAF. However, real world outcomes of concomitant hybrid convergent ablation and left atrial appendage (LAA) exclusion with an atrial clip are sparse. Hypothesis: To evaluate effectiveness of concomitant hybrid convergent ablation and LAA clipping in patients with long standing persistent AF (LSPAF). Methods: We conducted a retrospective analysis of all patients with LSPAF that underwent hybrid convergent ablation (surgical ablation plus endocardial catheter ablation) and LAA clipping at our institution. All patients had implantable cardiac devices (27.9% CIED and 81.4% ILR). ILRs were programmed to detect &gt;6-minute episodes of AF. Primary end point was recurrence of AF at 12 months. Results: A total of 43 patients underwent hybrid convergent ablation and LAA exclusion from 2019-2020. Mean age of the cohort was 64.9 + 8.9 years and 62.8% were male. 61.9% patients had previous AF catheter ablation and majority (84%) were on anti-arrhythmic drugs (AAD). LAA clipping was performed in all patients with a median clip size of 45. Mean time between the surgical and endocardial catheter ablation procedure was 2.6 + 1.7 months. All patients were continued on AAD following the hybrid procedure. Overall AF free survival on continued anti-arrhythmic drugs at 12 month follow up was 68.3%. Conclusions: Concomitant hybrid convergent ablation and LAA exclusion with an atrial clip provides reasonable long term AF free survival in patients with LSPAF.
Abstract 14309: Does Obesity Affect the Long-Term Results of Catheter Ablation of Atrial Fibrillation?
Authors: Nektarios Vasilottos, Awaneesh Kumar, Cody McCoy, Tanyanan Tanawuttiwat, John M Miller, Mithilesh Das
Journal: Circulation (2022)

Background: The presence of obesity in patients who underwent catheter ablation (CA) of atrial fibrillation (AF) is thought to be a predictor of poor outcomes. Methods: We studied the long-term success of CA of AF in patients with mild to severe obesity and followed them for recurrence of AF/atrial flutter (FL). Results: Of 185 patients (mean age: 60.3 ± 10.7 years, male: 75%), 24 (13%) patients had a normal body mass index (BMI &lt; 25.0 kg/m 2 ), 53 (28.6%) patients were overweight (BMI 25.0-29.9 kg/m 2 ), 78 (42.2%) patients were obese (BMI 30.0-39.9 kg/m 2 ) and 30 (16.2%) had severe obesity (BMI &gt; 40 kg/m 2 ). There were no significant differences in baseline characteristics including age, gender, race, left ventricular ejection fraction, and presence of hypertension, diabetes, and valvular disease. Number of ablations performed in the normal, overweight, obese, and severe obesity groups were 1.3 ± 0.5, 1.4 ± 0.6, 1.5 ± 0.6, and 1.5 ± 0.7, respectively. During a median (±1SE) follow-up of 5.23 ± 0.17 years, 79% in the normal BMI, 70% in overweight, 41% in obese, and 80% in severe obesity group were in sinus rhythm. There was no significant difference among all four groups regarding recurrence of AF/AFL (p=NS). Kaplan-Meier survival analysis showed no significant difference in time to recurrence of AF/AFL based on BMI. Conclusion: Severity of obesity does not predict recurrence of AF/AFL after CA during long-term follow-up.
Abstract 13588: Association of Longitudinal Trajectories of Branched Chain Amino Acids Through Young Adulthood With Diabetes in Later Life: The CARDIA Study
Authors: Konrad T Sawicki, Hongyan Ning, Norrina B Allen, Mercedes R Carnethon, Amisha Wallia, James D Otvos, Issam Ben Sahra, Elizabeth M McNally, Janet Snell-Bergeon, John T Wilkins
Journal: Circulation (2022)

Introduction: Branched chain amino acids (BCAA), measured at a single timepoint in midlife, are directly associated with risk for incident type 2 diabetes mellitus (DM), a strong determinant of cardiovascular disease risk. However, the trajectories (traj) of BCAAs through young adulthood and their associations with DM in midlife are unknown. Methods: We used NMR spectroscopy to measure serum BCAA levels from up to 3,081 Coronary Artery Risk Development in Young Adults (CARDIA) participants who attended the Year(Y) 2, 7, 15, 20, and 30 exams. We used latent class modeling to generate BCAA traj groups. To quantify associations between BCAA traj and prevalent DM* at the Y30 exam, we excluded participants with DM at Y2, and modeled traj groups from Y2 to Y30. To quantify associations between BCAA traj and incident DM by the Y30 exam, we excluded participants who developed DM by the Y20 exam and modeled traj from Y2 to Y20. We used adjusted** logistic regression to quantify the associations between traj group and prevalent and incident DM (at Y30), separately. Results: Among 3,081 participants (mean age at Y2: 27y), there were 3 BCAA traj groups: 1,427 participants in the low-stable group, 1,384 in the moderate-stable group, and 270 in the high-increasing group. Male sex, Black race, and higher body mass index were more common in the higher BCAA traj groups. Compared with the low-stable BCAA traj group (reference), the moderate-stable and high-increasing BCAA traj groups were associated with prevalent DM at Y30 (OR [95 th CI]: moderate-stable, 2.59 [1.90-3.55]; high-increasing, 6.03 [3.86-9.43]). Moderate-stable and high-increasing traj groups were associated with incident DM at Y30 (OR [95 th CI]: moderate-stable, 1.56 [1.02-2.39]; high-increasing, 2.20 [1.25-3.87]; low-stable, reference). Conclusions: BCAA levels track, on average, over a 28-year span in most young adults, but serial measurements identify subpopulations with rising levels and high risk of DM in later life.